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Effect of Enteral L...
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Hellström, Ann,1959University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
(author)
Effect of Enteral Lipid Supplement on Severe Retinopathy of Prematurity A Randomized Clinical Trial
- Article/chapterEnglish2021
Publisher, publication year, extent ...
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American Medical Association (AMA),2021
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LIBRIS-ID:oai:gup.ub.gu.se/302686
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https://gup.ub.gu.se/publication/302686URI
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https://doi.org/10.1001/jamapediatrics.2020.5653DOI
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https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-192306URI
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https://lup.lub.lu.se/record/d5e1b8eb-201f-4660-9e56-65e7d3acb98dURI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:145972910URI
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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IMPORTANCE Lack of arachidonic acid (AA) and docosahexaenoic acid (DHA) after extremely preterm birth may contribute to preterm morbidity, including retinopathy of prematurity (ROP). OBJECTIVE To determine whether enteral supplementation with fatty acids from birth to 40 weeks' postmenstrual age reduces ROP in extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS The Mega Donna Mega trial, a randomized clinical trial, was a multicenter study performed at 3 university hospitals in Sweden from December 15, 2016, to December 15, 2019. The screening pediatric ophthalmologists were masked to patient groupings. A total of 209 infants born at less than 27 weeks' gestation were tested for eligibility, and 206 infants were included. Efficacy analyses were performed on as-randomized groups on the intention-to-treat population and on the per-protocol population using as-treated groups. Statistical analyses were performed from February to April 2020. INTERVENTIONS Infants received either supplementation with an enteral oil providing AA (100mg/kg/d) and DHA (50mg/kg/d) (AA:DHA group) or no supplementation within 3 days after birth until 40 weeks' postmenstrual age. MAIN OUTCOMES AND MEASURES The primary outcomewas severe ROP (stage 3 and/or type 1). The secondary outcomes were AA and DHA serum levels and rates of other complications of preterm birth. RESULTS A total of 101 infants (58 boys [57.4%]; mean [SD] gestational age, 25.5 [1.5] weeks) were included in the AA:DHA group, and 105 infants (59 boys [56.2%]; mean [SD] gestational age, 25.5 [1.4] weeks) were included in the control group. Treatment with AA and DHA reduced severe ROP compared with the standard of care (16 of 101 [15.8%] in the AA:DHA group vs 35 of 105 [33.3%] in the control group; adjusted relative risk, 0.50 [95% CI, 0.28-0.91]; P =.02). The AA:DHA group had significantly higher fractions of AA and DHA in serum phospholipids compared with controls (overall mean difference in AA:DHA group, 0.82 mol% [95% CI, 0.46-1.18 mol%]; P <.001; overall mean difference in control group, 0.13 mol% [95% CI, 0.01-0.24 mol%]; P =.03). There were no significant differences between the AA:DHA group and the control group in the rates of bronchopulmonary dysplasia (48 of 101 [47.5%] vs 48 of 105 [45.7%]) and of any grade of intraventricular hemorrhage (43 of 101 [42.6%] vs 42 of 105 [40.0%]). In the AA:DHA group and control group, respectively, sepsis occurred in 42 of 101 infants (41.6%) and 53 of 105 infants (50.5%), serious adverse events occurred in 26 of 101 infants (25.7%) and 26 of 105 infants (24.8%), and 16 of 101 infants (15.8%) and 13 of 106 infants (12.3%) died. CONCLUSIONS AND RELEVANCE This study found that, compared with standard of care, enteral AA:DHA supplementation lowered the risk of severe ROP by 50% and showed overall higher serum levels of both AA and DHA. Enteral lipid supplementation with AA:DHA is a novel preventive strategy to decrease severe ROP in extremely preterm infants.
Subject headings and genre
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Nilsson, Anders K.,1982University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience(Swepub:gu)xnandd
(author)
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Wackernagel, D.Karolinska Institutet,Karolinska Institute,Karolinska University Hospital
(author)
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Pivodic, Aldina,1978University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience(Swepub:gu)xpival
(author)
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Vanpee, M.Karolinska Institutet,Karolinska Institute,Karolinska University Hospital
(author)
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Sjöbom, UlrikaUniversity of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för vårdvetenskap och hälsa,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap,Institute of Health and Care Sciences,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience(Swepub:gu)xsjobu
(author)
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Hellgren, Gunnel,1961University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för biomedicin,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap,Institute of Biomedicine,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience(Swepub:gu)xhegun
(author)
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Hallberg, B.Karolinska Institutet,Karolinska Institute,Karolinska University Hospital
(author)
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Domellöf, Magnus,1963-Umeå universitet,Pediatrik,Norrland University Hospital(Swepub:umu)mado0002
(author)
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Klevebro, SusannaKarolinska Institutet,Karolinska Institute,University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi,Institute of Neuroscience and Physiology,Stockholm South General Hospital(Swepub:gu)xklesu
(author)
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Hellström, WilliamUniversity of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institute of Clinical Sciences, Department of Pediatrics(Swepub:gu)xhelwi
(author)
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Andersson, Mats,1954University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi,Institute of Neuroscience and Physiology(Swepub:gu)xamaty
(author)
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Lund, Anna-MySahlgrenska University Hospital(Swepub:lu)an6638lu
(author)
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Löfqvist, Chatarina,1964University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för vårdvetenskap och hälsa,Institutionen för neurovetenskap och fysiologi,Institute of Health and Care Sciences,Institute of Neuroscience and Physiology(Swepub:gu)xlofch
(author)
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Elfvin, Anders,1971University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institute of Clinical Sciences, Department of Pediatrics,Sahlgrenska University Hospital(Swepub:gu)xelfan
(author)
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Sävman, Karin,1960University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institute of Clinical Sciences, Department of Pediatrics,Sahlgrenska University Hospital(Swepub:gu)xsavka
(author)
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Hansen-Pupp, IngridLund University,Lunds universitet,Pediatrik, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Neonatalogi,Forskargrupper vid Lunds universitet,Paediatrics (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Neonatology,Lund University Research Groups,Skåne University Hospital(Swepub:lu)pedi-ipu
(author)
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Hård, Anna-Lena,1949University of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
(author)
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Smith, L. E. H.Boston Children's Hospital,Harvard University
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Ley, DavidLund University,Lunds universitet,Pediatrik, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Neonatalogi,Forskargrupper vid Lunds universitet,Paediatrics (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Neonatology,Lund University Research Groups,Skåne University Hospital(Swepub:lu)pedi-dle
(author)
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Göteborgs universitetInstitutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap
(creator_code:org_t)
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In:JAMA Pediatrics: American Medical Association (AMA)175:4, s. 359-3672168-62032168-6211
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Hellström, Ann, ...
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Wackernagel, D.
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Pivodic, Aldina, ...
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Vanpee, M.
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Sjöbom, Ulrika
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